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Abstract
Background: Painful facial expressions have been shown to trigger affective responses among observers. However, there is
so far no clear indication about the self- or other-oriented nature of these feelings. The purpose of this study was to assess
whether facial expressions of pain are unconsciously associated with other-oriented feelings (empathic concern) or with
self-oriented feelings (personal distress).
Method: 70 participants took part in a priming paradigm in which ambiguous facial expressions of pain were primed by
words related to empathic concern, distress, negative or by neutral words. It was hypothesized that empathic concern or
distress-related words might facilitate the detection of pain in ambiguous facial expressions of pain, independently of a
mere effect of prime (i.e., neutral words) or an effect of valence congruency (negative primes).
Results: The results showed an effect of prime on the detection and on the reaction time to answer pain when confronted
to ambiguous facial expressions of pain. More specifically, the detection of pain was higher and faster when preceded by
distress primes relative to either neutral or negative primes.
Conclusion: The present study suggests that painful expressions are unconsciously related to self-oriented feelings of
distress and that their threat value might account for this effect. These findings thus shed new light on the automatic
relationship between painful expressions and the affective components of empathy.
Citation: Grynberg D, Maurage P (2014) Pain and Empathy: The Effect of Self-Oriented Feelings on the Detection of Painful Facial Expressions. PLoS ONE 9(7):
e100434. doi:10.1371/journal.pone.0100434
Editor: Alessio Avenanti, University of Bologna, Italy
Received January 17, 2014; Accepted May 27, 2014; Published July 1, 2014
Copyright: 2014 Grynberg, Maurage. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was also supported by grant 1.1233.09 from the Belgian National Fund for Scientific Research (FNRS-FRS) to Delphine Grynberg (Research
Fellow). Pierre Maurage is a FNRS Research Associate. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of
the manuscript. No additional external funding received for this study.
Competing Interests: The authors have declared that no competing interests exist.
* Email: Delphine.Grynberg@uclouvain.be
Introduction
Pain is defined as an unpleasant sensory and emotional
experience associated with actual or potential body damage.
Painful feelings can be expressed by various ways (e.g., facial
expressions, voice prosody), and it has been suggested that
witnessing someone expressing pain triggers empathic affective
responses in the observer (e.g., [1]). Nevertheless, the exact nature
of these affective responses remains largely undetermined, notably
concerning their orientation. Particularly, it is still unclear whether
these responses to pain are mostly oriented towards the self or
towards the others. Self-oriented responses can be globally defined
as feelings of discomfort and distress focusing on the reduction of
the observers own distress when witnessing anothers negative
experience, while other-oriented responses are warmth and
empathic concern focusing on the others well- being [2]. So far,
studies have mainly investigated the role of moderators on state
empathic affective responses (distress versus empathic concern) for
someone in pain (e.g., [3]) or the association between trait
measures of empathic affective responses and neural activation in
response to painful facial expressions [4,5]. In terms of situational
empathic affective responses, only one study has investigated the
Method
Participants
Seventy students in Psychology at the Universite Catholique de
Louvain (52 females) took part in the study. They were aged from
18 to 31 (M = 21.70; SD = 2.00). They were paid 8 Euros for their
participation. We obtained written informed consent from each
participant, which was approved by the ethical committee of the
Psychological Sciences Research Institute (Universite Catholique
de Louvain).
Material
Pre-test. A pretest phase was conducted in order to select 24
targets and 48 fillers of ambiguous facial expressions. For these
pre-tests, the paradigm was based on Yamada and Decetys [7]
study (see Fig. 1). In the original paradigm, participants were asked
to complete the priming task in which prime words were
subliminally presented for 25 msec. Each trial started with a
fixation cross (presented for a duration that varied between 1000
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Procedure
The instructions and the design of the main experiment were
identical to the pre-test except that the primes were words and not
symbols (see Fig. 1). Participants were requested to perform the
priming task, in which prime words were subliminally presented
for 25 msec followed by an ambiguous facial expression presented
for 750 msec. Participants were instructed to categorize the
expressed emotion. There were 6 blocks (one for each type of
morphing) of 96 trials each [for the target 50%50%: 16 trials per
category of prime (16*4 trials); for the fillers 40%60%: 4 trials per
category of prime (4*4 trials); for the fillers 60%-40%: 4 trials per
category of prime (4*4 trials)]. Because our main focus was the
50%50% stimuli and because the experiment lasted around
35 minutes, we wanted to reduce as much as possible the number
of less relevant stimuli (40%60% and 60%-40%). Therefore, we
decided to present less fillers than targets.
Statistical analyses
Signal Detection analysis (see [7]) was used in order to
investigate the sensitivity of pain detection in 50%50% ambiguous painful facial expressions. However, contrary to Yamada and
Decetys [7] methodology, we have decided to avoid presenting a
block without primes in order to keep participants attentional
focus intact. Furthermore, we have chosen to measure the
sensitivity (d-prime) only and not criterion (C) because this latter
reflects a response bias that is independent of the priming effect
(see [9]). Yamada and Decety [7] indeed used two indices of
detection signal theory: the sensitivity and criterion indices. The
sensitivity score corresponded to the difference between hits (pain
response when faces are preceded by primes) and false alarm
(pain response when faces are not preceded by primes) and the
criterion corresponded to the sum of these false alarm and hits. The
criterion thus refers to trials that are primed (hits) and unprimed
(false alarms). Therefore, in the present study, (1) a hit
corresponded to a pain response to ambiguous facial expressions
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250.69
232.33
1311.64
1308.85
3.28
3.24
5.44
5.48
231.78
197.44
1182.58
1213.80
2.98
3.14
9.96
9.97
236.24
176.73
1272.67
1246.85
8.57
Mean
3.42
8.58
Negative
3.41
322.45
SD
280.69
1329.52
1346.78
3.35
2.97
5.13
5.70
167.60
230.58
1181.70
1149.23
3.27
3.31
10.04
9.67
213.80
209.97
1271.27
8.69
Neutral
1273.24
3.31
8.49
Distress
3.36
1294.00
M
SD
3.37
5.46
M
SD
260.20
1185.60
M
SD
3.01
10.13
M
SD
217.75
1306.04
M
SD
3.53
RTs (ms)
Response
RTs (ms)
Response
Discussion
RTs (ms)
The average detection RTs scores for each pain block (and for
each prime) are presented in Table 1. The one-sample t test analysis
revealed that the difference between the RTs to detect pain in
ambiguous expressions of pain morphed with neutral expression
when primed with distress words relative to negative words was
different from zero (Mdifference = 264.57; SDdifference = 2178.93;
t(66) = 2.1.69; p = .004; Cohens d = .42; Table 2). This suggests
that participants are faster to detect pain in ambiguous expressions
of pain morphed with neutral expression when these expressions are
primed by distress words relative to negative words. The other
difference scores were not significant (ps..07). The difference scores
for the other ambiguous expressions (fear-happy; fear-neutral;
happy-neutral) were not significantly different from zero (ps..05).
These results suggest that painful expressions are associated with
self-oriented feelings independently of an effect of valence
congruency (Aim 3). However, these expressions are not more
associated with self-oriented than with other-oriented feelings (Aim
1).
Response
Reaction times
Pain Fear
The average detection scores for each pain block (and for each
prime) are presented in Table 1. The signal detection analysis
revealed that relative to neutral words, the pain sensitivity score to
ambiguous painful faces primed with distress words was significantly
above-chance level in the block fear-pain (M sensitivity = 0.10,
SDsensitivity = 0.39) (t(66) = 2.03 p = .046; Cohens d = .50; Table 2).
In other words, when ambiguous painful expressions are morphed
with fear, participants detect more often pain when these
expressions are primed with distress words relative to neutral
words. The other sensitivity scores for ambiguous painful
expressions were not significantly above-chance level (ps.
.054).The sensitivity scores for the other ambiguous expressions
(fear-happy; fear-neutral; happy-neutral) were not significantly
above-chance level (ps..28).
These results suggest that painful expressions are associated with
self-oriented feelings independently of a mere effect of priming
(Aim 2). However, painful expressions were not more particularly
associated with self-oriented or with other-oriented feelings (Aim
1).
Pain - Neutral
Responses
Pain - Happiness
Results
Continuum
Table 1. Descriptive data (Mean and Standard Deviation) of pain responses and reaction times to ambiguous expressions of pain (50%50%) for each type of prime.
298.91
Table 2. One-sample t tests for each type of ambiguous expression of pain (i.e., morphed with happiness, neutral, and fearful
expressions) and for each contrast.
Morphing
Pain- Happiness
Pain- Neutral
Pain- Fear
Responses
Reaction times
t (66)
t (65)
Distress - Compassion
20.15
21.87
Distress - Neutral
20.15
20.23
Distress - Negative
20.50
0.94
Distress - Compassion
21.96
21.54
Distress - Neutral
21.61
21.69
Contrast (Primes)
Distress - Negative
21.21
22.95***
Distress - Compassion
0.94
1.29
Distress - Neutral
2.03*
20.07
Distress - Negative
0.68
1.08
Note. For Responses, positive values correspond to higher sensitivity to detect pain in ambiguous expressions of pain primed with distress words relative to compassion,
neutral or negative primes. For Reaction Times, negative values correspond to quicker detection of pain in ambiguous expressions of pain primed with distress words
relative to compassion, neutral or negative primes.
* p,.05;
*** p,.005.
doi:10.1371/journal.pone.0100434.t002
Lamm et al.s [1] study has shown that when participants have to
imagine the other, there is a positive correlation between
situational empathic concern responses and the activation in the
anterior medial cingulate cortex (involved in the affective
dimension of pain). Another study showed that the activation of
the left anterior insula, also involved in the affective component of
pain processing, correlated positively with dispositional measures
of empathic concern but also of personal distress [5].
All together, these studies support that the processing of painful
expressions is associated to affective empathic responses. However,
future studies are needed to focus on the degree of automaticity of
self and other-oriented responses. Furthermore, because we did
not specifically investigate how painful expressions lead to self or
other-oriented feelings, no conclusions can be drawn about the
emotions elicited by pain in others. Future studies should thus also
focus on the exact nature of the situational affective responses to
someone expressing pain, at both subjective and neural levels, and
to assess the possible moderators and change over time of these
feelings.
One methodological constraint has to be considered. The results
did not reveal similar effects of prime on ambiguous expressions of
pain in terms of RTs and responses.
This effect might be accounted for by the possible presence of a
speed accuracy trade-off. The descriptive data indeed show that
while the condition with shorter latencies (pain-neutral) is
characterized by greater detection of pain, the condition with
longer latencies (pain-fear) is characterized by lower detection of
pain. Therefore, the association between painful expressions and
distress might have emerged in different ways depending on the
morphing.
A second limitation refers to a possible sex effect. It has indeed
been shown that females report higher empathy responses (e.g.,
[15]). Future studies should thus include more male participants
Conclusions
This study investigated for the first time if the activation of the
concept of distress and empathic concern would automatically
facilitate the processing of painful expressions. The present study
globally confirms, in a controlled design, the hypothesis that selforiented feelings of distress are associated with greater and rapid
recognition of ambiguous painful expressions and supports the
hypothesis that painful expressions may activate the avoidance
system. These results are thus a first step towards a further
exploration of the subjective and physiological aspects of these
feelings in response to someone expressing pain.
Acknowledgments
The authors would like to thank Caroline Poncelet for data collection.
Author Contributions
Conceived and designed the experiments: DG PM. Performed the
experiments: DG. Analyzed the data: DG PM. Wrote the paper: DG PM.
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